To see the characteristics, course and outcome of patients suffering from intracranial tuberculoma.
Retrospective review of 102 patients diagnosed as intracranial tuberculoma at a tertiary care center over 10 years.
A total of 102 cases were seen with an age range of 1 to 75 years (mean, 30 years). Predisposing factors included Diabetes mellitus (8 patients) and pregnancy or puerperium (7 patients). Five pediatric patients had tuberculoma despite documented BCG vaccination. Fever (59%), headache (57%), meningeal irritation (36%) were the commonest presenting features; one-third of patients were drowsy or comatosed at presentation. Cerebrospinal fluid analysis was performed in 63 patients, of whom 88% had elevated protein, 83% had low glucose, and 84% had pleocytosis (one-third with neutrophilia). Forty-nine (50%) patients had clinical or laboratory evidence of concomitant tuberculous meningitis, Chest radiographs showed active or old tuberculous infection (25%), with a miliary pattern in 20%. Two-thirds of subjects had multiple tuberculomas (mean, 4.5 lesions per patient) on contrast CT or MRI scan. Hydrocephalus was present in 37 (37%) patients of which 21 required shunt surgery. Thirty-nine patients had > 9 months of follow up; 17 patients showed complete recovery, 20 patients had partial recovery, and 2 patients had no response. Coma at presentation and miliary pattern on chest X-ray were predictors of poor prognosis.
The study demonstrate that fever, headache, signs of meningeal irritation and cranial nerve palsies are common presenting features. Complete recovery was seen in 40% patients. Coma and military TB are predictors of poor prognosis (JPMA 54:83;2004).
Journal of Pakistan Medical Association
Moolani, M. K.,
Khealani, B. A.,
Smego, R. A.,
Sarwari, A. R.
(2004). Prognostic indicators in patients with intracranial tuberculoma: a review of 102 cases. Journal of Pakistan Medical Association, 54(2).
Available at: http://ecommons.aku.edu/pakistan_fhs_mc_med_med/182